MEDICARE: YAISER ROQUE PEREZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11018860	FL

General Provider Information

NPI Number	:	1790502540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAISER ROQUE PEREZ APRN

Provider Business Mailing Address
First Line	:	17901 SUMMERLIN RD STE C
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5765
Country	:	US
Telephone Number	:	239-291-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 CREEKSIDE BLVD E UNIT 102
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0595
Country	:	US
Telephone Number	:	239-624-8070
Fax Number	:	239-624-8071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	03/18/2026

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Directions to “ YAISER ROQUE PEREZ APRN” Practice Location

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